Provider Demographics
NPI:1124319934
Name:WEISS, HERBERT S (RPH, CPH)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-6009
Mailing Address - Country:US
Mailing Address - Phone:863-382-8273
Mailing Address - Fax:
Practice Address - Street 1:6008 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-6009
Practice Address - Country:US
Practice Address - Phone:863-382-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18086183500000X
NY21574183500000X
FLPU2053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist